Heart failure is one of the most important causes of morbidity and mortality in the United States. Both HIV and cocaine abuse can cause left ventricular (LV) dysfunction (systolic, diastolic or both), possibly resulting from separate mechanisms. These etiologies have not been thoroughly investigated. The pathological processes preceding the development of global LV dysfunction are commonly regional in nature. While HAART improves survival in patients with HIV, their impact on LV dysfunction still is not fully understood. The proposed study will enroll 800 black men and women, aged 25-45 years, who have no evidence of hypertension or coronary artery disease or symptoms believed to be due to cardiovascular disease: 200 will be HIV (+) and cocaine (+); 200 HIV (+) and cocaine (-); 200 HIV (-) and cocaine (+); and 200 HIV (-) and cocaine (-). Interviews, echocardiographic examinations, lipid profiles, serum cytokines and other blood tests will be performed at baseline. The study subjects will be re-examined 2 years later and followed up at least 2 years. The specific aims of the study are: 1) to estimate the prevalence and incidence of regional and global LV dysfunction 2) to investigate the factors associated with the development of regional and global LV dysfunction 3) to investigate the impact of HAART on the development of regional and global LV dysfunction 4) to investigate the individual and joint effects of HIV infection, cocaine use risk behaviors, and other factors, including cigarette smoking, alcohol use, lipid profile, and C-reactive protein and cytokines on the development of regional and global LV dysfunction in black men and women. This study has the potential to provide critical information about the impact of HIV, cocaine abuse and HAART on the development of LV dysfunction.